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Mary Forhan remembers meeting a severely obese woman whose life had shrunk to the reclining chair in her living room.

It started with an injury from a car crash, followed by reduced work hours and roles. Depression followed, as did disability and isolation, in part because the woman became too big to get into her car to do a grocery run, or sit in a restaurant chair.

The woman spoke to her doctor about extreme hip pain, Forhan said, but nothing was done, in part because the woman wouldn't fit into the X-ray machine. Only when another doctor pushed for a creative solution did the woman find out she had been walking on a broken hip for 18 months.

"There's still this perception that people did this to themselves and therefore aren't entitled to the resources," Forhan said. The mantra was, and often still is: If you lost weight you would feel better.

But Forhan said, "If someone without obesity had fallen and complained of hip pain, they would probably be in hospital having surgery within a pretty reasonable amount of time. That would be it."

As a new high-profile recruit to Edmonton, Forhan, an occupational therapist turned researcher and professor, aims to improve the quality of care given to obese people to ensure they can live their lives more fully.

In the next five years as a professor in the University of Alberta's faculty of medicine and department of occupational therapy, Forhan wants to come up with proven standards that help obese people raise their children, remain employed at work, or simply bathe themselves properly.

She'll write curriculum that will train new occupational therapists, nurses and doctors treating obese people. She says people in the medical community are starting to understand that obesity is not a behaviour, but a chronic disease like cancer, with no easy diet-and-exercise cure.

"Weight loss is not an outcome that I'm really interested in," Forhan said. "I think that will be a byproduct of any effective intervention if that's the appropriate goal for the patient."

For instance, Forhan believes obese patients who need help putting their socks on should have access to a shoe horn to help them. Yet that therapeutic approach has come up against resistance.

People have asked her why she teaches people with obesity to conserve energy rather than expend it.

"There's a mentality, too, that by shaming people into making things more difficult it will motivate them to change their obesity, which is so ridiculous."

Forhan said she wants patients to conserve energy doing mundane things so they aren't exhausted before doing meaningful activities, like taking the dog for a walk or goofing around with their children.

Forhan also remembers another patient who gained independence and mobility by using a walker with a seat and wheels - until her doctor told her to park it.

"You need to burn more calories," the doctor told the woman, even though the walker - perceived as a lazy choice - was helping her do exactly that, reducing the risk of falling while also giving the woman needed rests, Forhan said. "I know clinically and intuitively it is helping, but we need the evidence," Forhan said.

There is no such evidence, or standards of care, when it comes to occupational therapy for the severely obese. Twelve years ago, Forhan was the first and only occupational therapist in the country - perhaps even the world - to talk about rehabilitation in relation to obesity. Since then, she estimates about 20 occupational therapists worldwide are working in the area.

It may seem an obvious link, but Forhan said back then, many obese people didn't show up at the hospital until they were acutely ill, largely because they faced such stigma.

Dr. Arya Sharma, a University of Alberta obesity expert who serves as scientific director for the Canadian Obesity Network, recruited Forhan from McMaster University in Hamilton, Ont., and a cardiac rehabilitation hospital in Toronto.

"We have one of the largest obesity clinics right here in Edmonton, and the whole area of bariatric rehab, that's an area that is extremely underdeveloped," Sharma said. One in four adults and one in 10 children are clinically obese - double the number since 1981, according to the Public Health Agency of Canada. Those numbers are still rising, and Sharma said Forhan will help further cement Edmonton's reputation as leader in the field of obesity research.

The University of Alberta has the only dedicated bariatric suite in Canada to train health professionals how to work safely with obese patients and specialized equipment. The room includes:

An extra-wide wheelchair

A ceiling-anchored lift for a 700-pound person

A portable lift to carry a maximum load of 660 pounds

A training mannequin weighing 400 pounds

A commode chair with a 500-pound capacity; it can be placed over a regular toilet seat A reclining chair

A hospital bed with a 1,000-pound capacity

A scale that will measure up to 900 pounds; most scales have a weight capacity of 400 pounds or less

Long-handled nail clippers

Long-handled bath sponge

Long-handled shoe horn and sock aid

Extra-wide visitor chair and seat

Extra-long blood pressure cuff

Hospital gowns for large people

A device to help people with difficulties reaching behind their body to clean themselves after a bowel movement

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